From the case files

An obligation to report concerns

In this issue we share a case where a locum GP raised concerns about patient safety in a practice he had worked at for three months

Dr V had recently finished training as a GP. He had just completed a three month locum at a practice in England when he contacted MPS for advice on handling concerns about systems failings at the practice, which he believed put patients at risk. He had discussed the issues in broad terms with his former trainer who agreed that the systems described were flawed.

Before leaving he had discussed his concerns with the senior partner who appeared receptive but he was later informed by the practice manager that it was not agreed that the risk to patients was significant. Dr V was uncertain to what extent his concerns had been shared with the other partners at the practice.

Dr V believed he had an obligation to report his concerns but he did not want to cause any difficulties for the practice and feared a negative effect on his career; moreover, he did not know how to go about it.

Dr V was told that he was correct in his assessment of his obligations and referred to the GMC guidance Raising and acting on concerns about patient safety.1 By reference to this document, the options were discussed and the following actions were agreed.

First, he had only raised his concerns verbally so it was agreed that he should write to all the partners and the practice manager setting out his concerns in writing. As he was no longer at the practice it was reasonable to expressly seek a response and a tangible reassurance that action would be taken. The letter would need to be carefully crafted to avoid appearing presumptuous and causing offence. MPS agreed to review the draft.

In the absence of a suitable response from the practice Dr V would need to consider escalating his concerns to the performance management group of the NHS England Area Team.

Having done this, he would, in all likelihood, have discharged his obligations as it was reasonable to expect the Area Team to take control of the situation. However, he would need to consider reporting the matter to the CQC and/or the GMC if he believed that the Area Team was part of the problem or he learnt that their response had been inadequate. It was pointed out that he had an obligation to report immediate and serious risks to patients to the regulator with a responsibility to intervene; in this case most probably the CQC. However, it was agreed that the risk identified did not reach that threshold.

MPS provided Dr V with advice in relation to the tone, style and content of his draft letter to the practice. Upon receipt of the letter the practice arranged a meeting with Dr V in order to discuss the issues that he had raised. The practice took a positive approach to the concerns that Dr V had raised and instigated an action plan to rectify the relevant issues. As a consequence of the action taken by the practice Dr V was sufficiently reassured and did not consider he had an obligation to escalate matters further.

Learning points

A doctor has a duty to act where there is a risk to patient safety irrespective of any negative effects on themselves or of any loyalties.

It is sufficient that a doctor reasonably believes that this might be the case. They do not need proof. In this case, Dr V discussed his concerns with his former trainer. This was very helpful but had he not been able to do so, he would have had to rely on his own honest assessment of the issues.

Wherever possible, concerns must be raised following a stepwise process, usually starting with the doctor’s immediate line manager, escalating internally to the individual responsible for clinical governance or in overall charge.

Unless there is an immediate and serious risk to patients, external escalation will be to the Area Team in the first instance followed, in the absence of a suitable response, by involvement of the CQC and/or GMC.

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